Diabetes Information

As our name DiabeVita suggests, we are especially interested in the treatment, management and prevention of diabetes. Dr. Hilts, the family doctor at DiabeVita's Scottsdale office, is a diabetic, and empathizes with the challenges her patients face every day. More than 50 million people in the US are currently diabetic or are facing its preliminary stages. Fortunately, a combination of lifestyle changes, education and treatment recommendations can get the disease under control and allow you to enjoy a full healthy life.

On this section of our site, we offer information and educational articles to enhance your understanding of this widespread but controllable disease. Read through this overview article and follow the links to other pages on our site for even more detail. We also have reading suggestions and links to other sites of educational interest.

Dr. Hilts often gives talks about diabetes to the community and to other doctors. She describes how she felt after being diagnosed with diabetes herself in 2004, and what she has learned since then that keeps the disease under control - in her case without any medication. A great slide presentation Dr. Hilts developed to show how diabetes affects the body, and what to do about it, can be viewed from this site. Watch "A Doctor With Diabetes - How Diabetes Works". You can also listen to Dr. Hilts share her thoughts on managing diabetes with a low-carb lifestyle in a podcast interview.

The following is an overview discussion about the nature of diabetes, what causes it, how to prevent it, and our recommendations on how to best treat the disease. The more informed you are, the better you can take care of your health.

What Is Diabetes?

Diabetes means high blood sugar. Diabetes occurs when our pancreas doesn’t produce enough natural insulin to help our bodies keep our blood sugar at the proper level. The majority of cells in the pancreas produce enzymes which are used to help us digest the food we eat. A tiny portion (1%) of pancreas cells are known as beta cells, the only cells in the body which can create insulin. Insulin is a hormone which helps guide the glucose (sugar) in our bloodstream to where it needs to go to produce energy that powers every part or our body, our muscles, brain, heart and other vital functions. Diabetes becomes a serious illness that, if not controlled, can lead to blindness, heart disease, strokes, kidney failure and amputations. It kills over 210,000 people each year. But, there are millions of people with diabetes who are enjoying long, active, happy and fulfilling lives with proper self care, medical treatment, wise eating and moderate exercise.

Two Types of Diabetes

Type 1 diabetes occurs when virtually all of the beta cells in your pancreas have died and your pancreas is unable to produce any natural insulin. This can happen at any age, but most often occurs in children and young adults. Type 1 diabetics require daily injections of insulin. It is also called “brittle diabetes” because without the natural fine tuning of blood sugar by the beta cells, blood sugars can go very high and very low easily. This yo-yo effect can be greatly reduced with a low-carb diet.

Type 2 is the most common form of diabetes. Type 2 used to be mostly associated with older patients, but now is quite common in children. Either the body does not produce enough insulin or the cells in the body ignore the insulin (insulin resistance), which stops glucose from moving out of the bloodstream and into the cells. This imbalance between natural insulin and too much blood sugar can often be regulated by proper diet and moderate exercise, without insulin injections.

What Causes Diabetes?

We are all born with a certain number of insulin-producing beta cells in our pancreas. Under normal circumstances, there are enough beta cells to last us an entire lifetime. But, poor diet (too much junk food and too many sweet drinks), lack of exercise and, unfortunately, genetics, can lead to the development of diabetes.

By the time someone is diagnosed with diabetes, 50-80% of the beta cells in the pancreas are dead, and the remaining beta cells are tired and overworked. The body does not create new beta cells – once gone there are no new ones created to take their place. That means the remaining beta cells can’t produce enough natural insulin to control our level of blood sugar. If the person has insulin resistance their pancreas has to make up to 4 times as much insulin as typically required to bring the blood sugar down to normal. When there is not enough insulin for the blood sugar, we begin to see the common symptoms of diabetes:

• Frequently tired
• Often hungry or thirsty
• Vision problems
• Frequent urination
• Yeast infections
• Get infections more easily

How Does Diabetes Damage The Body?

Most of the damage done by diabetes is mechanical, and very preventable. The two main culprits are high blood sugar, and insulin resistance with resultant high insulin levels. The only way to prevent (and actually reverse some of) the damage is to keep all of your numbers normal, the way the body was designed to work: normal blood sugar (70-120, or 140 max); normal insulin levels (not too high or too low); normal blood pressure (less than 130/80); and normal cholesterol and triglycerides. The good news is that when your blood sugar and insulin levels are normal, the other numbers go down, too. And it’s not hard to do naturally.

The first culprit in diabetes damage is high blood sugar (glucose). Glucose is a small, very reactive molecule which, at higher-than-normal levels, attaches itself to most other molecules in the body, a process called glycosylation (means glucose-izing). It will latch onto most protein molecules – the lively little machines which do most of the active work in the body - and interfere with their function. The higher your blood sugar is, the more glycosylation occurs. We measure this with a Hemoglobin A1C (HbA1C) test, which tells us how much sugar has attached itself to your hemoglobin molecules over the last 2-3 months. HbA1c reflects the level of glycosylation on all the molecules in your body, including in your brain, nerves, kidneys, heart and blood vessels. Glycosylation also occurs on lipids, which make up every cell membrane, and on DNA. This may be part of the reason people with uncontrolled diabetes have higher rates of cancer.

Cross-linking occurs when the blood sugar level is more than 160. This means the sticky, reactive sugar molecules start permanently gluing larger molecules to each other. Cross-linking is how plastic is made. Plastic is useful for storing things but not much good inside a living body. Scientists have actually extracted a gooey, brown plastic (which fluoresces yellow) from the legs of poorly controlled diabetics.

The other culprits in diabetes are insulin resistance with resulting high insulin levels. These two always travel together. They raise blood pressure, total cholesterol, LDL cholesterol, triglycerides, free radicals, oxidants, blood clots and total inflammation, especially in the blood vessels. Most Type 2 diabetics have insulin resistance and high insulin levels for years before they finally develop diabetes. It is easy to see how this can result in the heart disease and strokes which kill most poorly controlled diabetics, and many pre-diabetics as well.

Insulin is also THE fat storing hormone, which makes it very difficult to lose weight if your insulin levels are high. High insulin levels make you hungry, too.

What causes insulin resistance?

Insulin resistance means the body requires higher than normal amounts of insulin to lower blood sugar. Insulin is the key which unlocks the glucose gate in cell membranes, to allow glucose in the blood to enter the cell as fuel. Insulin is a hormone which has other jobs, too, but being the key to the glucose gate is job number one. Insulin resistance means the cells are not allowing the insulin to easily unlock the glucose gate, so higher levels of insulin are required to get the job done.

There is a vicious cycle between insulin resistance, high insulin levels and high blood sugar. Insulin resistance causes us to make or require high levels of insulin to overcome the cells’ resistance to insulin. Meanwhile the blood sugar is rising because the sugar can’t move from the blood into the resistant cells. Insulin resistance itself is immediately caused by high blood sugar or high insulin levels. Insulin resistance, high insulin levels and high blood sugar all feed on each other. This is a vicious cycle which is easy to break.

Being overweight, especially around the middle, is also both cause and effect of insulin resistance. That belly will reduce most quickly if you keep your blood sugars and insulin levels normal.

Heredity plays a part in insulin resistance, but how we take care of ourselves affects what genes are expressed! So we can’t just blame our parents.

When someone who is insulin resistant eats carbohydrates (sugars and starches) their insulin level skyrockets within minutes. Over the next 3-7 hours they will make up to 4 times as much insulin as the body was originally designed to work with. If they had not eaten the carbs their insulin levels would have stayed more normal. When the insulin resistance is finally overcome by the high levels of insulin, the blood sugar can drop below normal, which makes people very hungry (irritable and foggy-headed, too). And the food they crave when blood sugar is low is carbs! Carbs immediately raise blood sugar levels, which raise insulin levels, which eventually drop blood sugar, which makes us hungry for more carbs. Another vicious cycle.

Remember that insulin is THE fat storing hormone, so high levels of insulin make it very difficult to lose weight. Excess fat in the body increases insulin resistance, which raises insulin levels, which stores fat. A third vicious cycle.

So how do we break all of these vicious cycles? The five ways to reduce insulin resistance are:

• Keep blood sugars normal
• Keep insulin levels down to normal
• Lose weight
• Exercise
• Medication (metformin and thioglitazones)

The first three items are easiest to achieve with a low-carb diet. In fact, for diabetics it is almost impossible to maintain normal blood sugar without yoyo-ing high and low if you eat carbs. It is also almost impossible to maintain or require normal insulin levels if you eat carbs, once you are diabetic or pre-diabetic.

How Is Diabetes Treated?

When we don’t have enough beta cells in our pancreas to produce the proper amount of insulin, or our body does not respond to normal levels of insulin creation (insulin resistance), we need to eat wisely and exercise, reduce insulin resistance, and sometimes supplement our natural insulin production with medicines.

Proper Diet For Diabetes

The best diet for diabetics is one that is low in carbohydrates (sugars and starches) That’s because much more insulin is required to handle incoming carbohydrates than for fats and protein. And carbohydrates raise diabetics’ blood sugars very quickly. We can make blood sugar and other fuels for our bodies out of proteins, vegetables, fats and oils. We do not have to eat any carbohydrates at all.

The great news is that once you give up the carbs, the craving for carbs goes away very quickly.

Low-carb diets can facilitate weight reduction–a major goal for most diabetics. People who eat low-carb need much lower amounts of diabetes medicine, including insulin, so they have less risk of LOW blood sugar and other side effects. And low-carb diets reduce insulin resistance which improves high blood pressure, high triglycerides and high cholesterol.

If someone is insulin resistant, every time they eat carbohydrates their poor pancreas must produce 4 times as much insulin as normal. If they are Type 1 and insulin resistant they must inject much larger quantities of insulin to bring their blood sugar down. Type 2’s will never regrow the beta cells that have been worked to death, but when they eat low-carb their beta cells can rest and even recover some function. This can happen early in Type 1 diabetics as well.

Two concerns that people have about low-carb diets are about excessive protein, and lack of vitamins and minerals. Several large recent studies on humans (not rats which are harmed by high protein diets) have shown that high protein diets do not harm human kidneys unless the kidneys are already very damaged. We know that high blood sugar damages kidneys rapidly, so it is best to do everything possible to keep blood sugars normal. Regarding nutrients, all the vitamins, minerals and enzymes found in fruits and grains are in vegetables and sources of protein.

What To Eat: Protein and 2-3 veggies at each meal, 3 times a day

Include PROTEIN in every meal:

• If it walks, swims or flies, it’s protein! Includes meat (beef, pork, etc.), fish and chicken
• Eggs & cheese (low-fat is best)
• Beans – small portions only because they have lots of carbs, too
• Nuts & nutty seeds (sunflower, pumpkin, sesame)
• Soy

Include 2-3 VEGGIES in every meal: Lettuce, spinach, cabbage, squash, broccoli, cauliflower, peppers, chilies, avocados, eggplant, okra, celery, cucumber are a few examples of low-carb vegetables. Small amounts of onion or tomato are OK.

• Always eat a meal within 2 hours of waking up - a low-carb breakfast
• Snacks should be protein or veggies, too.
• Keep good tasting, healthy foods ready, handy and visible, and take some with you.
• Use bland vegetables in place of pasta or rice, under sauces.
• “Honey, can I have a bite of yours?” An occasional bite of someone else’s dessert is OK.
• If you splurge, go for a walk right away. (No big splurges unless you’re climbing mountains)

What To Avoid: Carbohydrates

Carbohydrates are sugars and starches. Sugar is a simple molecule shaped like a ring with a tail. Starches are just chains of sugar, which start to be broken into sugar by the enzymes in your saliva as soon as you begin to eat. To your body starch is sugar. The foods listed below all contain large amounts of starch and/or sugar, and include roots, fruits, grains and milk. All the vitamins, enzymes and minerals they have are found in vegetables and proteins as well, so AVOID THESE FOODS:

• No Roots: Potatoes, sweet potatoes, carrots, beets (a little onion or garlic for flavor is OK)
• No Fruits: Oranges, apples, pears, grapefruit, cherries, peaches, melon, pineapple. No fruit juices: an 8 oz. glass of 100% orange juice has 6-7 teaspoons of sugar!.
• No grains: Wheat (even whole wheat), bread, corn, rice, oats (including oatmeal & breakfast cereal)
• No Milk: Not even non-fat or 2%. The lactose in milk is milk sugar.

One typical so-called serving of carbohydrates (15 grams - equivalent to one slice of bread) will raise a diabetic’s blood sugar by about 50 points.

4 grams of carbohydrate equals 1 teaspoon of sugar! Look at the amounts of carbohydrates on the nutrition labels of packaged foods. Pay attention to what they call a serving. You only have to do this once for each food to learn something. Keep in mind that nutrition labels can be off by 20%, legally. This makes it very difficult to estimate how much insulin to inject for those who need it.

It is OK to eat small portions of carbohydrates (15 grams) immediately before or during exercise, because it goes straight to your muscles for fuel without raising your blood sugar or insulin levels.

Proper Exercise For Diabetes

Exercise is medicine. This is particularly true for diabetics. Exercise burns up carbs, lowers blood sugar, reduces insulin resistance, calms the appetite and helps us lose weight. We all need a way to continually burn off the carbs we take into our bodies every day. Fortunately, just 30 minutes of moderate activity (like a brisk walk) can lower your blood sugar level by 50 points or more, or burn up that half a potato you just ate.

Exercise reduces insulin resistance immediately and long term, which makes you more naturally sensitive to your own insulin, and to your medicine. This is one of the ways it helps people to lose weight. Studies have shown (and common sense has observed) that regular exercise improves mood, sleep and general health.

The key ingredient in any successful exercise program is daily exercise. You don’t have to lift heavy weights, run 10 miles a day or leap tall buildings in a single bound. But, if you want to eat every day, then you need to exercise for at least 30 minutes every day. Both cardio exercise and resistance (using weights) have been shown to be very good for diabetes. It is best to keep moving, whatever form of exercise you do.

Choose one or several activities you can enjoy: briskly walking with your partner, children, grandchildren or a friend, walking the dog, swimming, hiking, biking, working out at the gym, cleaning the floor on your hands and knees, active yoga, vigorous gardening, basketball, ballroom dancing, exercise DVDs or dancing at home.

Small changes make a big difference: use the stairs, park farther away, walk or bike short distances, wash the car yourself, mow the lawn, etc. When you feel your muscles working that’s good! Choose to enjoy what you do. Attitude makes a huge difference. Most people notice they are stronger with more endurance within a week after starting to exercise!

If you just read all this, congratulations for being proactive in pursuing optimum health! We’re here to help you on your journey; contact us for an appointment; come to one of our group classes; or learn more here.